We focus a lot on how students can prove they're good enough for medicine. These posts are for students wondering if medicine is good enough for them.
Short Version: Medicine absolutely requires a solid understanding of scientific principles and facts, as well as an ability to critically analyze new scientific studies or discoveries. The common undergraduate precursors to a career in medicine are based in scientific study, for good reason. Scientific research is intimately connected to medicine, and involvement in research can be beneficial to a prospective physicians' career goals before, during, and after medical school. An interest in science is therefore a common reason why students choose to pursue medicine.
Medicine is an inherently applied field, however - when it comes to the nuts and bolts of scientific discovery, the basic or fundamental research that underlies much of humanity's technological progress, physicians rarely get involved. Rather, physicians involved in research tend to spend most of their time on clinical research, which investigates potential applications of discoveries others have made. This can be an advantage or a disadvantage, depending on individual preferences. Science-loving potential medical students should give some thought to how they want to incorporate scientific knowledge into their careers and ensure that being a physician will satisfy that objective.
Long Version: Modern medicine could not exist without the development of the scientific method and its continual application to new realms of human knowledge. To the extent physicians' interventions are effective in preventing death or improving life, it is thanks to the works of physicians and scientists in the past and present. As such, it is impossible for a capable physician to exist without a solid understanding of both prior scientific discoveries as well as the process that leads to new scientific discoveries.
Furthermore, the pathway to become a physician, with some uncommon exceptions, requires a solid scientific background. Medical school admissions has moved away from requiring certain degrees or pre-requisite courses, but most still require the science-heavy MCAT and the vast majority of medical students do their undergraduate education in science, math, social sciences, or engineering. Put simply, the pathway to medicine runs through science and therefore medicine attracts those with a proclivity towards scientific study.
Part of the path to medicine for many students includes becoming actively involved in scientific research. Research is by no means required for admissions to any medical school in Canada, but it can certainly help with the admissions process at the majority of schools. Even at schools that do not consider research in their admissions process, or do not weigh it heavily, many matriculants will have significant research experience. There continues to be some value to engaging in research after admissions. Many residency programs will take research experience into account. This is usually as a secondary consideration to clinical performance, however, and research is really only required for a few highly-competitive fields. Once in residency, most programs will have required research projects, and research productivity can be important for landing positions after residency, depending on specialty and desired location of employment.
Yet, despite its close ties to the study and advancement of scientific knowledge, medicine is far more concerned with application of new discoveries than in their production. Physicians are largely involved with what is termed "clinical research" as opposed to foundational research or basic sciences research. To oversimplify somewhat, clinical research involves study on humans. For ethical reasons, we tend not to allow such research without having some expectation as to what will happen, so clinical research generally involves relying heavily on knowledge derived from basic sciences research, typically performed by non-physicians. This is not to diminish the difficulty or importance of clinical research, which is fraught with challenges and is critical to developing truly evidence-based medical practice. However, it does speak to the place of physicians within the process of developing new approaches to medicine - if a useful new intervention in medicine takes 100 steps to become discovered, developed, optimized, and proven effective, physicians involved in research are usually responsible for the last couple steps only, with an emphasis on optimization and proving efficacy rather than on discovery or development.
To many, this limited role of physicians in the scientific process is not a drawback. Many physicians have no desire to be involved in research at all, even those enthralled by the miracles of science. Medicine is vast and learning how properly apply the ocean of scientific information relevant to one's practice can be plenty of mental stimulation for science-minded individuals. Similarly, for those interested in advancing medical knowledge but are uninterested in the basic sciences research students typically encounter in their undergraduate studies, clinical research can be an ideal way to satisfy that objective.
At this point, the growing demographic of clinician-scientists deserves recognition. Clinician-scientists are physicians who have additional training towards becoming capable researchers, usually through intensive graduate work. In some cases, the focus remains on clinical research, with clinician-scientists doing much the same research that an academic physician without additional training would undertake, but with perhaps a bit more expertise and often with a greater proportion of time spent on research activities rather than on clinical duties. Other clinician-scientists, however, will try to straddle the divide between clinical and basic sciences research. Translational research, with its emphasis on taking or making new scientific discoveries and bringing them into clinical practice, is receiving substantial attention in academic circles. Clinician-scientists, with focused training in basic sciences research, are considered ideally placed to take advantage of these opportunities.
The number of these clinician-scientists is fairly small, however, and not without reason. Becoming established as both a clinician and basic sciences researcher requires a substantial amount of time. A physician typically does not enter independent practice until their early 30's, and the same can be said for most basic sciences researchers. To manage a career in both areas can easily require a person to train into their late 30's or early 40's before independence in medical practice and research are achieved. That additional time spent training means losing significant financial opportunities, that extended training delays entry into employment. Additionally, research tends to pay less than clinical work, meaning clinician-scientists often earn less than their clinician-only counterparts.
Additionally, not all who pursue clinician-scientist training take advantage of both their intended roles. Many individuals who obtain both an MD and a PhD, whether that PhD was obtained before, during, or after medical school, do no research or research that could easily be accomplished with an MD alone. Likewise, there is a small group of clinician-scientists who no longer work with patients in a clinical setting, or who have minimal clinical duties, effectively working off their PhD alone. Obtaining both an MD and PhD can be an attractive prospect for highly ambitious students, but should be approached with caution and with as full an understanding of the clinician-scientist role as possible.
To summarize, medicine absolute involves scientific knowledge and benefits from those interested in science. Being interested in science is a good reason to consider medicine! Yet, potential medical students must keep in mind that an MD prepares students to be clinicians first and researchers second, with a focus on clinical research only. A physician's use of scientific knowledge is usually confined to direct applications for patients. For those who would strongly prefer to do research outside of a clinical setting, or those who have minimal interest in working with patients, an MD may not be the best fit, and those students would likely be better served in a PhD-only program. For those who truly want to do both, the clinician-scientist route, which usually involves completion of both an MD and a PhD, may be worthwhile. Science-lovers should take the time to check out all their options before diving into a career in medicine that may or may not be tailored to their specific interests.
Showing posts with label considering medicine. Show all posts
Showing posts with label considering medicine. Show all posts
Saturday, 25 February 2017
Saturday, 7 January 2017
Considering a Career in Medicine - Helping Others
We focus a lot on how students can prove they're good enough for medicine. These posts are for students wondering if medicine is good enough for them.
Short Version: A desire to help others is a critically important trait for an excellent physician to possess. However, a desire to help others provides little reason to go into medicine ahead of a plethora of other careers which also provide significant benefits to others. Physicians do provide assistance to their patients of course, but the effectiveness of that assistance is variable and often overestimated. Medicine is an inexact science and there will always be some patients who are harmed despite theoretically optimal management. Furthermore, even for physicians who make every effort to provide the best care for their patients, mistakes will be made and patients will suffer the consequences. Overall, physicians do improve the lives of those they serve and have the potential to be very impactful, yet need to maintain awareness of their limitations.
Long Version: I consider a desire to help others to be a near-necessity for a competent, compassionate physician. Many things can be and are taught in medical training, but empathy – and the passion to utilize it consistently – is not. Medicine therefore seems like a natural fit for caring, intelligent individuals who want to use their abilities to do some good in their communities or the world at large, with a career that reflects that focus on benefiting others first.
Yet, medicine is far from unique in being beneficial to others. Within healthcare, there is a multitude of careers which directly benefit patients in need in exceedingly meaningful ways. Physicians rarely, if ever, act alone in their administration of medicine, nor would they be effective acting independently of other professions within healthcare. Nurses, pharmacists, social workers, dentists, medical laboratory technologists, medical radiation technologists, audiologists, speech language therapists, physiotherapists, occupational therapists, EMTs... it goes on. Patients don't always need help from a physician and rarely need help from a physician only.
Additionally, non-healthcare workers can have a huge impact on people's health. Many of the gains seen in health over the past century are not attributable to advances in medicine or the delivery of healthcare. Increased wealth, better working conditions, improved nutrition, and cleaner environments have all played significant roles. Future gains (or holds) in human health are very likely to continue to involve those working in these fields, whether in the public, non-profit, or private sectors.
Of course, human needs extend beyond healthcare, and there are many ways to contribute to others' lives. Jobs in local charities, social development, education, and policing are often considered to be in the service of others. Careers not traditionally though of as being for the sake of others are nevertheless invaluable in our society, such as farming, construction, entertainment, or even (some) financial services. The perception that certain careers help people more than others is just that, a perception. Similar to the discussion on prestige, such perceptions are often unfounded and apply to the aggregate. An ethically-minded, competent banker can be of significant help to their clients. An unethical, incompetent physician can be an immense burden on their patients. The individual often matters more than the profession when it comes to the effect, positive or negative, on those around them.
Nevertheless, by improving health, physicians absolutely make a positive impact on their patients. Medical advances have undoubtedly extended life and improved its quality. Physicians, acting to implement those advances, are a critical part of maintaining if not furthering that positive change in the world. There have been times in my training already where the positive impact of medicine could not be denied. A man 10 years cancer-free and officially declared cured. A father, admitting that he was at his limit and taking the first step in getting help for long-standing depression. A mother getting to finally take her child home for the first time after months in hospital. These moments stick with you and many more interactions will occur where the benefit to the patient is not immediately obvious.
Yet at the end of the day, how much of an impact will a typical physician have? Likely a lot less than expected. While human health has improved, as noted above, much of that is due to societal advances outside of medicine. Likewise, much of the benefits of medical advances can be attributed to non-physicians. Where physicians can take responsibility for gains in health, those gains are often fairly limited. Most interactions with patients will not result in meaningful change to their health. Some patients require no intervention. Others require a test that does not end up changing management. Others will undergo indicated treatment that, by chance, produces no benefit. That last instance is far more common than the public often believe; if an intervention has been demonstrated in high-quality trials to help 1 in 10 people who receive that treatment - meaning 9 in 10 will receive no benefit - it has a higher rate of benefit, not to mention a stronger evidence base, than much of what is done in medicine.
Medical interventions also come with risks and harms. The phrase "do no harm", often associated with the Hippocratic Oath (though it does not appear in the original text), is notably absent from the modern version I took when I entered medical school. There's good reason for that as to be a physician necessarily means causing some harm. To provide optimal care is to accept risk, so some negative outcomes are inevitable. Expected benefits should always outweigh expected risks or harms, but the element of chance does not always turn out in our favour.
To go a step further, all the above applies to a physician providing optimal care. That is, one who is making no major mistakes or errors in judgment. No physician practices perfectly 100% of the time. With luck, most mistakes will be minor or lead to reversible harms, but bigger mistakes happen too, even to the best physicians.
I want to leave this post on a positive message, because physicians do have the potential to do significant good in the world and, importantly, the profession is strengthened by those with altruistic intentions. I do want future physicians to come in with a degree of realism, however, as too often the ideals of medical students run up against the realities of current practice and idealism gets replaced by cynicism. Likewise, on the other side of the spectrum, some physicians get through their training continuing to overestimate their impact and become conceded, failing to recognize the important contributions of non-physicians within and outside of healthcare. Aspiring physicians are not wrong to pursue medicine as a way to help others, but as with the previous post on money, medicine is not the indisputably best pathway towards helping others and as a result, alternative careers are worth contemplating.
Yet at the end of the day, how much of an impact will a typical physician have? Likely a lot less than expected. While human health has improved, as noted above, much of that is due to societal advances outside of medicine. Likewise, much of the benefits of medical advances can be attributed to non-physicians. Where physicians can take responsibility for gains in health, those gains are often fairly limited. Most interactions with patients will not result in meaningful change to their health. Some patients require no intervention. Others require a test that does not end up changing management. Others will undergo indicated treatment that, by chance, produces no benefit. That last instance is far more common than the public often believe; if an intervention has been demonstrated in high-quality trials to help 1 in 10 people who receive that treatment - meaning 9 in 10 will receive no benefit - it has a higher rate of benefit, not to mention a stronger evidence base, than much of what is done in medicine.
Medical interventions also come with risks and harms. The phrase "do no harm", often associated with the Hippocratic Oath (though it does not appear in the original text), is notably absent from the modern version I took when I entered medical school. There's good reason for that as to be a physician necessarily means causing some harm. To provide optimal care is to accept risk, so some negative outcomes are inevitable. Expected benefits should always outweigh expected risks or harms, but the element of chance does not always turn out in our favour.
To go a step further, all the above applies to a physician providing optimal care. That is, one who is making no major mistakes or errors in judgment. No physician practices perfectly 100% of the time. With luck, most mistakes will be minor or lead to reversible harms, but bigger mistakes happen too, even to the best physicians.
I want to leave this post on a positive message, because physicians do have the potential to do significant good in the world and, importantly, the profession is strengthened by those with altruistic intentions. I do want future physicians to come in with a degree of realism, however, as too often the ideals of medical students run up against the realities of current practice and idealism gets replaced by cynicism. Likewise, on the other side of the spectrum, some physicians get through their training continuing to overestimate their impact and become conceded, failing to recognize the important contributions of non-physicians within and outside of healthcare. Aspiring physicians are not wrong to pursue medicine as a way to help others, but as with the previous post on money, medicine is not the indisputably best pathway towards helping others and as a result, alternative careers are worth contemplating.
Saturday, 26 November 2016
Considering Medicine - Prestige
We focus a lot on how students can prove they're good enough for medicine. These posts are for students wondering if medicine is good enough for them.
Short Version: Medicine a well-regarded profession. Most people generally assume physicians are reasonably intelligent and high-achieving. Perceptions of the profession are slowly changing, however, and not necessarily for the better. More importantly, prestige essentially represents the opinions of others based on superficial qualities and only matter to the extent that those opinions are valued. Prestige in a career is often most meaningful to those who feel their job lacks prestige. As such, its main value is in assuaging personal insecurities, but it can only do so much on that front. Having a prestigious profession is no substitute for developing strong personal self-esteem. At the end of the day, prestige is a hollow comfort if a physician does not find the actual work of their job satisfying.
Long Version: Humans are social beings. We intrinsically care about what others think of us, even when those opinions fail to represent reality. It is in this light that we should consider the prestige of going into medicine.
The majority of individuals have positive opinions about physicians. In multiple polls, medicine is still regarded as one of the more respected, ethical, and trustworthy professions. Physicians tend to be thought of as intelligent and hard-working. Becoming a physician is often thought of as an achievement in isolation. Being a physician has many of the trappings of prestige, of being though of positively by society - with the "Dr." title, high pay, often an office, many times physicians get additional awards, or honours, or academic appointments.
It is hard to deny that medicine is a prestigious profession. Yet their are some cracks in public perception of physicians. With high earnings, physicians' earnings are coming into question, with concerns about the value the profession places on money. As medical knowledge disseminates more broadly, the expertise of physicians is more frequently under scrutiny by patients. Moreover, physicians can be seen as cold or uncaring when failing to meet the typically high expectations of empathy. If physicians ever were implicitly trusted because of their profession alone, that time has long passed.
What often gets lost in conversations about professional prestige is that while professions may have general qualities, they're made up of individuals. Individuals have their own qualities which may adhere to or contrast with those of their profession. For example, a physician isn't intelligent because they're a physician - they're intelligent because what they have acquired a good base of knowledge and the problem-solving skills necessary to use that knowledge effectively. The vast majority of physicians are intelligent, having the mental faculties to make complex clinical decisions competently, but there are exceptions. Becoming a physician doesn't instill intelligence automatically and as a result, a small minority of physicians are not particularly bright. Likewise, choosing to not become a physician will not remove intellect from an already-intelligent person.
So why should prestige matter at all? Well, it gets back to that original question - we care what others think of us. Furthermore, we want those positive opinions of us even when we don't have the time or opportunity to demonstrate our true qualities. It's not feasible or socially acceptable to demonstrate your level of intelligence to every person we meet. Our careers provide a proxy for who we are as people, whether we think that proxy reflects who we are or not. Being a physician provides a benefit of the doubt other professions often don't.
That benefit of the doubt can be a small comfort, however, when knee-deep in the medical profession. If there's one group of people unimpressed by someone being a physician, it's other physicians. In medicine, particularly in the training phase, guess who you'll be spending most of your time with? Likewise, most of the non-physicians you work with won't be overly impressed by your job. Nurses, pharmacists, PSWs, RTs, and the gamut of other healthcare workers have been around physicians long enough not to be in awe of the title. They will generally like you as a physician if you work well with them and do a good job for your patients, but will never like you because you're a physician.
The bottom line is that a prestigious career provides some benefits in terms of how you're viewed by others, especially those who don't know you well. When choosing a career based on prestige alone, you could do much worse than medicine. Yet, prestige is a weak and inconsistent shield against the judgments of others. Not everyone views physicians in a positive light, particularly those in regular close proximity to physicians. Therefore, as with any career, having the self-esteem to recognize who you are as a person, independent of how your job is viewed, is vital. If you don't have the confidence in your own abilities or value, being a physician will not provide much help to assuage those feelings. Similarly, if you do have confidence in who you are, that will show through regardless of what your career happens to be.
In the end, I believe that the prestige of the career is a positive reason to become a physician, but an exceedingly minor one. If a physician enjoys their work and the other aspects of medicine, the prestige of medicine is a helpful perk. For those that aren't as thrilled by the job itself, prestige is a poor consolation prize.
Short Version: Medicine a well-regarded profession. Most people generally assume physicians are reasonably intelligent and high-achieving. Perceptions of the profession are slowly changing, however, and not necessarily for the better. More importantly, prestige essentially represents the opinions of others based on superficial qualities and only matter to the extent that those opinions are valued. Prestige in a career is often most meaningful to those who feel their job lacks prestige. As such, its main value is in assuaging personal insecurities, but it can only do so much on that front. Having a prestigious profession is no substitute for developing strong personal self-esteem. At the end of the day, prestige is a hollow comfort if a physician does not find the actual work of their job satisfying.
Long Version: Humans are social beings. We intrinsically care about what others think of us, even when those opinions fail to represent reality. It is in this light that we should consider the prestige of going into medicine.
The majority of individuals have positive opinions about physicians. In multiple polls, medicine is still regarded as one of the more respected, ethical, and trustworthy professions. Physicians tend to be thought of as intelligent and hard-working. Becoming a physician is often thought of as an achievement in isolation. Being a physician has many of the trappings of prestige, of being though of positively by society - with the "Dr." title, high pay, often an office, many times physicians get additional awards, or honours, or academic appointments.
It is hard to deny that medicine is a prestigious profession. Yet their are some cracks in public perception of physicians. With high earnings, physicians' earnings are coming into question, with concerns about the value the profession places on money. As medical knowledge disseminates more broadly, the expertise of physicians is more frequently under scrutiny by patients. Moreover, physicians can be seen as cold or uncaring when failing to meet the typically high expectations of empathy. If physicians ever were implicitly trusted because of their profession alone, that time has long passed.
What often gets lost in conversations about professional prestige is that while professions may have general qualities, they're made up of individuals. Individuals have their own qualities which may adhere to or contrast with those of their profession. For example, a physician isn't intelligent because they're a physician - they're intelligent because what they have acquired a good base of knowledge and the problem-solving skills necessary to use that knowledge effectively. The vast majority of physicians are intelligent, having the mental faculties to make complex clinical decisions competently, but there are exceptions. Becoming a physician doesn't instill intelligence automatically and as a result, a small minority of physicians are not particularly bright. Likewise, choosing to not become a physician will not remove intellect from an already-intelligent person.
So why should prestige matter at all? Well, it gets back to that original question - we care what others think of us. Furthermore, we want those positive opinions of us even when we don't have the time or opportunity to demonstrate our true qualities. It's not feasible or socially acceptable to demonstrate your level of intelligence to every person we meet. Our careers provide a proxy for who we are as people, whether we think that proxy reflects who we are or not. Being a physician provides a benefit of the doubt other professions often don't.
That benefit of the doubt can be a small comfort, however, when knee-deep in the medical profession. If there's one group of people unimpressed by someone being a physician, it's other physicians. In medicine, particularly in the training phase, guess who you'll be spending most of your time with? Likewise, most of the non-physicians you work with won't be overly impressed by your job. Nurses, pharmacists, PSWs, RTs, and the gamut of other healthcare workers have been around physicians long enough not to be in awe of the title. They will generally like you as a physician if you work well with them and do a good job for your patients, but will never like you because you're a physician.
The bottom line is that a prestigious career provides some benefits in terms of how you're viewed by others, especially those who don't know you well. When choosing a career based on prestige alone, you could do much worse than medicine. Yet, prestige is a weak and inconsistent shield against the judgments of others. Not everyone views physicians in a positive light, particularly those in regular close proximity to physicians. Therefore, as with any career, having the self-esteem to recognize who you are as a person, independent of how your job is viewed, is vital. If you don't have the confidence in your own abilities or value, being a physician will not provide much help to assuage those feelings. Similarly, if you do have confidence in who you are, that will show through regardless of what your career happens to be.
In the end, I believe that the prestige of the career is a positive reason to become a physician, but an exceedingly minor one. If a physician enjoys their work and the other aspects of medicine, the prestige of medicine is a helpful perk. For those that aren't as thrilled by the job itself, prestige is a poor consolation prize.
Saturday, 12 November 2016
Considering a Career in Medicine - Money
We focus a lot on how students can prove they're good enough for medicine. These posts are for students wondering if medicine is good enough for them.
Short Version: Once established, a physician in Canada can expect to make a solid six figure income, with significant variation based on specialty, location, and practice type. However, it takes quite a bit of time and debt to become established. As such, delays in financing typical life goals are common. Money management skills are necessary to financial security, particularly when considering retirement, as physicians face different financial considerations than most individuals. Physicians often find themselves in trouble when they fail to control their spending habits and adequately save for the future. The high income in medicine is often a result of long hours worked, not just high hourly wage. Lastly, any career path should be considered with alternatives in mind, as students may have other, equally lucrative options.
Long Version: A desire for money is often thought of as an unsatisfactory reason to get into medicine, but money matters and income is an important consideration when planning a career. In Canada, physicians' income is high relative to most other countries, with the notable exception of our neighbours in the United States. There is significant variation in incomes for physicians. Specialty is the greatest factor, with lower-earning specialties like Psychiatry, Family Medicine, and Pediatrics earning closer to $200,000 on average, while high-earning specialties like Radiology or many surgical specialties earning in the range of $400,000 or higher. These figures are after accounting for overhead, but before taxes. Within each specialty there is a range of incomes as well depending on location, type of practice, and commonly performed services. It is not uncommon for practitioners to earn more - sometimes significantly more - than the averages quoted above.
Put simply, physicians have very good incomes, reliably putting them in or near the top 1% of earners in Canada. This high floor on earnings does come with a relative ceiling on income, however. Whereas similarly high-earning professions like law or business see elite performers earn several times what the average person in their field makes, physicians do not see that degree of stratification. The public healthcare system rewards quantity and with limited numbers of hours in the day, there's only so much physicians can do to see more patients and thereby increase their income. As a result, it is quite rare for a physician, even one in a high-earning specialty, to net over $1 million per year. Physicians are high earners, but students should not be expecting obscene levels of wealth.
Timing is also important when it comes to income and overall wealth generation, as the financial benefits of being a physician are not realized until after completing a long period of training, typically while accruing a fair amount of debt. A 40 year old physician tends to have more financial freedom than their peers in other careers. A 30 year old physician usually doesn't. This can complicate the achievement of non-career life goals that tend to occur in a person's late 20's or early 30's, such as buying a house, getting married, or having children, all of which carry a significant expense. All of these milestones are achievable as a medical trainee or recent graduate, but compromises are typically necessary. Some events will be delayed. Others will be lessened in scope - a smaller house, or a more modest wedding ceremony. Still more may be achieved only through added debt. Early career aspirations may need to take a back seat to income-generation. Over their career, physicians earn plenty of money to justify the initial time and debt invested, but the payoff is later in life, not earlier.
Once established, physicians' finances get easier in theory, but in practice, many continue to struggle. Physicians are notoriously poor money-managers and it can get them into serious financial difficulty. A mid-career physician has an enviable income, but can often set themselves up to have equally high expenses. After years of hard work and sacrifice, many physicians fall into the trap of spending too much and saving too little. This is particularly important as the vast majority of doctors do not have an employer-provided pension, meaning significant personal savings are required for a comfortable retirement. Jobs in medicine do not tend to have benefits either, residency being the notable exception, so physicians must also manage that expense out of their income. Failure to properly prioritize expenses through careful budgeting can leave physicians with significant money-related stress, despite having ample resources.
It should be kept in mind that the high earnings in medicine tend to come with long hours. Overall income can seem a lot less impressive when put in terms of an equivalent hourly wage, particularly once taking account all the unpaid aspects to a career in medicine. I hope to expand on this more in future posts.
Ultimately, when considering a career from a monetary perspective, a comparison must be made to alternative pathways, which can vary wildly person-to-person. If a student leaves undergrad with strong career prospects outside of medicine, they'll likely get far less of an overall gain from going to medical school than someone graduating their undergrad with zero immediate job prospects. In rare cases, going into medicine can be a financial negative. All students considering medicine should be actively developing alternatives to becoming a physician and should make the decision whether or not to enter medical school in light of those alternatives. Medical students tend to be intelligent, hard-working, communicative individuals who could be successful in a number of careers aside from medicine - it shouldn't be assumed that becoming a physician is the optimal choice from a monetary point of view, though it is often the lowest-risk pathway to ensure a six-figure income.
To sum up, there are some strong financial incentives to consider medicine. A physician can expect to be well-off to outright wealthy, but there are some caveats and physicians do need to budget their expenses to maintain financial security. Proper planning, with realistic expectations, is critical.
Timing is also important when it comes to income and overall wealth generation, as the financial benefits of being a physician are not realized until after completing a long period of training, typically while accruing a fair amount of debt. A 40 year old physician tends to have more financial freedom than their peers in other careers. A 30 year old physician usually doesn't. This can complicate the achievement of non-career life goals that tend to occur in a person's late 20's or early 30's, such as buying a house, getting married, or having children, all of which carry a significant expense. All of these milestones are achievable as a medical trainee or recent graduate, but compromises are typically necessary. Some events will be delayed. Others will be lessened in scope - a smaller house, or a more modest wedding ceremony. Still more may be achieved only through added debt. Early career aspirations may need to take a back seat to income-generation. Over their career, physicians earn plenty of money to justify the initial time and debt invested, but the payoff is later in life, not earlier.
Once established, physicians' finances get easier in theory, but in practice, many continue to struggle. Physicians are notoriously poor money-managers and it can get them into serious financial difficulty. A mid-career physician has an enviable income, but can often set themselves up to have equally high expenses. After years of hard work and sacrifice, many physicians fall into the trap of spending too much and saving too little. This is particularly important as the vast majority of doctors do not have an employer-provided pension, meaning significant personal savings are required for a comfortable retirement. Jobs in medicine do not tend to have benefits either, residency being the notable exception, so physicians must also manage that expense out of their income. Failure to properly prioritize expenses through careful budgeting can leave physicians with significant money-related stress, despite having ample resources.
It should be kept in mind that the high earnings in medicine tend to come with long hours. Overall income can seem a lot less impressive when put in terms of an equivalent hourly wage, particularly once taking account all the unpaid aspects to a career in medicine. I hope to expand on this more in future posts.
Ultimately, when considering a career from a monetary perspective, a comparison must be made to alternative pathways, which can vary wildly person-to-person. If a student leaves undergrad with strong career prospects outside of medicine, they'll likely get far less of an overall gain from going to medical school than someone graduating their undergrad with zero immediate job prospects. In rare cases, going into medicine can be a financial negative. All students considering medicine should be actively developing alternatives to becoming a physician and should make the decision whether or not to enter medical school in light of those alternatives. Medical students tend to be intelligent, hard-working, communicative individuals who could be successful in a number of careers aside from medicine - it shouldn't be assumed that becoming a physician is the optimal choice from a monetary point of view, though it is often the lowest-risk pathway to ensure a six-figure income.
To sum up, there are some strong financial incentives to consider medicine. A physician can expect to be well-off to outright wealthy, but there are some caveats and physicians do need to budget their expenses to maintain financial security. Proper planning, with realistic expectations, is critical.
Saturday, 5 November 2016
Advising Highschoolers and Undergrads on Medicine
If you're in high school or undergrad and interested in medicine, it's not hard to find opinions on whether you should pursue becoming a physician. Parents will weigh in, mentors will weigh in, classmates and friends will weigh in. Critically, physicians have their own views on whether prospective medical students should become doctors, and they tend to share those opinions, liberally. It is not difficult to find those viewpoints online or in print.
And those viewpoints are diverse. Very diverse. On one hand, which gets promoted by universities and physician organizations, you have the physicians who feel that medicine is a wonderfully unique career, that they derive immense satisfaction from, which is worth considering and striving for. On the other hand, which more frequently comes up in anecdotes of prospective medical students who have asked physicians they know about the field, is the notion that medicine will suck your life away with all its demands on your time and energy, and thus should be avoided like the plague.
So what's a potential future physician to think? Is medicine an incomparable opportunity for success, or a dangerous trap leading to unhappiness?
It'd like to come out and say the truth in somewhere in the middle, but I'd say it's more like it's both at once. It's undeniable that medicine provides many opportunities - both personal and professional - that are not easy to come by in other fields. Already, I've had the chance to see and to do and to experience more than I likely would had I stayed in my previous career. I have new perspectives I never would have experienced in any other profession. Yet, I've also had to give up a lot of things I care about to continue on in medicine, more than once going through long periods of exhaustion or being overwhelming, experiencing despair bordering on depression.
My expectations for life have been revised upwards in many ways, while being simultaneously revised down in many other aspects.
That may sound bleak, but I don't view it that way. Life is about making choices, and those choices come with consequences, both good and bad. We can't take advantage of every opportunity - our time and energy are limited. Going into medicine was a choice that has had some positives, some negatives. Some of these trade-offs I was aware of heading into medical school. Others I knew about, but failed to fully appreciate. Still others seemingly came out of nowhere.
When a physician gives a judgment on their satisfaction with their career, or their views on medicine as a vocation in general, they tend to be giving a summary opinion on those trade-offs, perhaps highlighting the good or bad aspects that matter to them the most in forming that opinion. Yet its digging into the trade-offs that the answer becomes clear and each person will place different value on the pros and cons of the profession. To make matters more confusing, as people grow over time and experience new elements of the profession, their viewpoints will change - my own verdict as to whether going into medicine was the right choice or not has jumped around multiple times and continues to do so, even after 4 years of medical school.
So, should a student considering medicine take the plunge? Maybe. It depends on a number of factors, including current situation in life, career alternatives, life goals or priorities, and personality. Making any career choice is too complex to put into a binary "yes-or-no" answer and apply it to everyone. That's doubly true for medicine, a field with significant sunk costs and limited opportunities to smoothly transfer to another career (especially early on). Sorting through the meaningful considerations is well beyond the scope of a single blog post, and should ideally involve an active conversation rather than passive reading.
However, recognizing that not everyone has a physician they can talk to in-depth about all aspects of medicine, I think it's worth having some general information available on what a student can expect from a career in medicine. Over the next little while in a series of posts, I would like to explore some of these factors in greater detail. I can't provide a full weighing of preferences, but perhaps I can provide some context.
And those viewpoints are diverse. Very diverse. On one hand, which gets promoted by universities and physician organizations, you have the physicians who feel that medicine is a wonderfully unique career, that they derive immense satisfaction from, which is worth considering and striving for. On the other hand, which more frequently comes up in anecdotes of prospective medical students who have asked physicians they know about the field, is the notion that medicine will suck your life away with all its demands on your time and energy, and thus should be avoided like the plague.
So what's a potential future physician to think? Is medicine an incomparable opportunity for success, or a dangerous trap leading to unhappiness?
It'd like to come out and say the truth in somewhere in the middle, but I'd say it's more like it's both at once. It's undeniable that medicine provides many opportunities - both personal and professional - that are not easy to come by in other fields. Already, I've had the chance to see and to do and to experience more than I likely would had I stayed in my previous career. I have new perspectives I never would have experienced in any other profession. Yet, I've also had to give up a lot of things I care about to continue on in medicine, more than once going through long periods of exhaustion or being overwhelming, experiencing despair bordering on depression.
My expectations for life have been revised upwards in many ways, while being simultaneously revised down in many other aspects.
That may sound bleak, but I don't view it that way. Life is about making choices, and those choices come with consequences, both good and bad. We can't take advantage of every opportunity - our time and energy are limited. Going into medicine was a choice that has had some positives, some negatives. Some of these trade-offs I was aware of heading into medical school. Others I knew about, but failed to fully appreciate. Still others seemingly came out of nowhere.
When a physician gives a judgment on their satisfaction with their career, or their views on medicine as a vocation in general, they tend to be giving a summary opinion on those trade-offs, perhaps highlighting the good or bad aspects that matter to them the most in forming that opinion. Yet its digging into the trade-offs that the answer becomes clear and each person will place different value on the pros and cons of the profession. To make matters more confusing, as people grow over time and experience new elements of the profession, their viewpoints will change - my own verdict as to whether going into medicine was the right choice or not has jumped around multiple times and continues to do so, even after 4 years of medical school.
So, should a student considering medicine take the plunge? Maybe. It depends on a number of factors, including current situation in life, career alternatives, life goals or priorities, and personality. Making any career choice is too complex to put into a binary "yes-or-no" answer and apply it to everyone. That's doubly true for medicine, a field with significant sunk costs and limited opportunities to smoothly transfer to another career (especially early on). Sorting through the meaningful considerations is well beyond the scope of a single blog post, and should ideally involve an active conversation rather than passive reading.
However, recognizing that not everyone has a physician they can talk to in-depth about all aspects of medicine, I think it's worth having some general information available on what a student can expect from a career in medicine. Over the next little while in a series of posts, I would like to explore some of these factors in greater detail. I can't provide a full weighing of preferences, but perhaps I can provide some context.
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